Background/Objectives: Glioblastoma (GBM) is the most common primary malignant central nervous system tumor, accounting for 50.9% of malignant CNS diagnoses and carrying a median survival of 15 months despite maximal standard therapy. High recurrence rates are driven by residual infiltrative tumor cells at the resection margin. Fluorescence-guided surgery (FGS) has emerged as a key innovation to improve intraoperative tumor visualization and maximize the extent of resection (EOR). This review examines the historical development, current clinical applications, and future directions of FGS in GBM surgery.Methods: A comprehensive literature review was conducted, covering the evolution of fluorophores (fluorescein, indocyanine green [ICG], and 5-aminolevulinic acid [5-ALA]), visualization technologies (wide- and narrow-field modalities), therapeutic adjuncts (photodynamic and sonodynamic therapies), and clinical adoption patterns and outcomes.Results: Early intraoperative fluorescence using fluorescein dates to 1947. ICG angiography has broad surgical utility, while 5-ALA received FDA approval in 2017, with phase III trials demonstrating gross total resection rates of 65% versus 36% with white-light surgery. Adjunct technologies—3D exoscopes, FGS-compatible loupes, and quantitative spectroscopy probes—enhance detection of residual tumor. Preliminary studies of intraoperative photodynamic and sonodynamic therapies show feasibility and potential survival benefits. Global adoption of 5-ALA FGS exceeds 75% among surveyed neurosurgeons.Conclusions: FGS significantly improves EOR in GBM surgery, translating into better patient outcomes. Ongoing clinical trials and technological refinements—novel fluorophores, quantitative imaging, and therapeutic applications—promise to further optimize tumor visualization and treatment.
背景/目的：胶质母细胞瘤（GBM）是最常见的原发性恶性中枢神经系统肿瘤，占恶性中枢神经系统肿瘤诊断的50.9%，即使在接受最大程度标准治疗后，其中位生存期也仅为15个月。高复发率主要由切除边缘残留的浸润性肿瘤细胞驱动。荧光引导手术（FGS）已成为改善术中肿瘤可视化和最大化切除范围（EOR）的关键创新技术。本综述探讨了FGS在GBM手术中的历史发展、当前临床应用及未来方向。 方法：进行了全面的文献综述，涵盖荧光剂（荧光素、吲哚菁绿[ICG]和5-氨基乙酰丙酸[5-ALA]）的演变、可视化技术（宽视野和窄视野模式）、治疗辅助手段（光动力和声动力疗法）以及临床采用模式和结果。 结果：术中荧光素荧光技术的早期应用可追溯至1947年。ICG血管造影具有广泛的手术应用价值，而5-ALA于2017年获得美国食品药品监督管理局批准，其III期试验显示，与白光手术36%的肿瘤全切率相比，5-ALA引导下的肿瘤全切率达到65%。辅助技术——3D外视镜、兼容FGS的手术放大镜和定量光谱探针——增强了残留肿瘤的检测能力。术中光动力和声动力疗法的初步研究显示了其可行性和潜在的生存获益。在接受调查的神经外科医生中，5-ALA FGS的全球采用率超过75%。 结论：FGS显著提高了GBM手术的切除范围，从而改善了患者预后。正在进行的临床试验和技术改进——新型荧光剂、定量成像和治疗应用——有望进一步优化肿瘤可视化和治疗。
Fluorescence-Guided Surgery for Gliomas: Past, Present, and Future
肿瘤(癌症)患者之家